Clinical manifestations and diagnosis of diabetic polyneuropathy
- Eva L Feldman, MD, PhD
Eva L Feldman, MD, PhD
- Professor of Neurology
- University of Michigan Medical Center
There are many forms of diabetic neuropathy including symmetric polyneuropathy, autonomic neuropathy, radiculopathies, mononeuropathies, and mononeuropathy multiplex (table 1). (See "Epidemiology and classification of diabetic neuropathy".)
The clinical manifestations and diagnosis of diabetic polyneuropathy, also referred to as diabetic neuropathy, will be reviewed here. The pathogenesis and treatment of this disorder and the characteristics of the other forms of diabetic neuropathy are discussed separately. (See "Pathogenesis and prevention of diabetic polyneuropathy" and "Treatment of diabetic neuropathy".)
Diabetic polyneuropathy is primarily a symmetrical sensory polyneuropathy, initially affecting the distal lower extremities. Ten to 18 percent of patients have evidence of nerve damage at the time their diabetes is diagnosed, suggesting that even early impairment of glucose handling, classified as prediabetes, is associated with neuropathy. With disease progression, sensory loss ascends and, when reaching approximately mid-calf, appears in the hands. This gradual evolution causes the typical "stocking-glove" sensory loss. This pattern reflects preferential damage according to axon length; the longest axons are affected first. Motor involvement with frank weakness occurs in the same pattern, but only later and in more severe cases.
Symptoms and signs — The earliest signs of diabetic polyneuropathy probably reflect the gradual loss of integrity of both large myelinated and small myelinated and unmyelinated nerve fibers:
●Loss of vibratory sensation and altered proprioception reflect large-fiber loss
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- CLINICAL MANIFESTATIONS
- Symptoms and signs
- Natural history
- CRITERIA FOR DIAGNOSIS
- Screening tests
- - United Kingdom screening test
- - Michigan Neuropathy Screening Instrument
- - Tuning fork test
- Electrodiagnostic tests
- Staging test
- - Michigan Diabetic Neuropathy Score
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS